Provider Demographics
NPI:1407304884
Name:OKON, MEGAN COLLEEN (APN)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:COLLEEN
Last Name:OKON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:COLLEEN
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10458 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4933
Mailing Address - Country:US
Mailing Address - Phone:708-636-1818
Mailing Address - Fax:708-636-2151
Practice Address - Street 1:10458 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4933
Practice Address - Country:US
Practice Address - Phone:708-636-1818
Practice Address - Fax:708-636-2151
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily